%0 Journal Article
%T The Shared Pathoetiological Effects of Particulate Air Pollution and the Social Environment on Fetal-Placental Development
%A Anders C. Erickson
%A Laura Arbour
%J Journal of Environmental and Public Health
%D 2014
%I Hindawi Publishing Corporation
%R 10.1155/2014/901017
%X Exposure to particulate air pollution and socioeconomic risk factors are shown to be independently associated with adverse pregnancy outcomes; however, their confounding relationship is an epidemiological challenge that requires understanding of their shared etiologic pathways affecting fetal-placental development. The purpose of this paper is to explore the etiological mechanisms associated with exposure to particulate air pollution in contributing to adverse pregnancy outcomes and how these mechanisms intersect with those related to socioeconomic status. Here we review the role of oxidative stress, inflammation and endocrine modification in the pathoetiology of deficient deep placentation and detail how the physical and social environments can act alone and collectively to mediate the established pathology linked to a spectrum of adverse pregnancy outcomes. We review the experimental and epidemiological literature showing that diet/nutrition, smoking, and psychosocial stress share similar pathways with that of particulate air pollution exposure to potentially exasperate the negative effects of either insult alone. Therefore, socially patterned risk factors often treated as nuisance parameters should be explored as potential effect modifiers that may operate at multiple levels of social geography. The degree to which deleterious exposures can be ameliorated or exacerbated via community-level social and environmental characteristics needs further exploration. 1. Introduction Over the last decade, chronic exposure to ambient air pollution has become increasingly recognized as an important risk factor underlying adverse pregnancy outcomes (APOs) [1每9]. In parallel, the associations between socioeconomic status (SES) and APOs are among the most robust findings in perinatal research [10每12], which persist even in settings with universal access to health care [13每16]. While interest in the intersection between health and the social environment is long standing [17每19], renewed attention has been propelled by two independent progressions in quantitative research. The first is the popularization of multilevel statistical models and the ability to separate the individual-level effects from those of their encompassing social and physical environments [20每26]. The second is the emerging research on the biological effects of psychosocial stress on health and its modification by environmental factors. There is now mounting evidence that stress can interact with chemical exposures to exacerbate the toxic effect and the physiological response to a greater extent than
%U http://www.hindawi.com/journals/jeph/2014/901017/